While medications for three interconnected chronic conditions — cardiovascular disease, diabetes and obesity — represent a growing proportion of employers’ drug spend, there’s plenty that can be done to help employees’ slow the progression of these conditions while managing drug plan costs, said Joyce Wong, director of clinical services at Express Scripts Canada, during Benefits Canada’s 2023 Face to Face Drug Management Forum in December.

According to Express Scripts’ 2022 drug claims data, 29 per cent of claims were for a medication related to cardiovascular disease — such as blood pressure medications, cholesterol medications and blood thinners — and these claims represented 10 per cent of overall spend. Wong noted many of the drugs in that category have been around for a long time and have low-cost generics available. The number of claimants for heart disease medications year-over-year has remained relatively flat.

Read: How plan sponsors, insurers are considering coverage of weight-loss drugs amid rising use of Ozempic

Diabetes medication and insulin represented 10 per cent of all claims but 14 per cent of overall spend and growing. Just 0.4 per cent of claims were for obesity drugs, representing 0.7 per cent of spend, but Wong noted getting data on obesity was a challenge, as 65 per cent of plan members currently don’t have access to medications for weight loss or obesity through their plans.

A third of plan members were diagnosed with at least one of these three conditions and the combined drug costs represented 25 per cent of Express Scripts’ overall drug spend.

A quarter of cardiovascular drug claimants also had diabetes drug claims and 0.5 per cent had obesity drug claims. Among diabetes drug claimants, 82 per cent had cardiovascular drug claims, though Wong noted diabetes treatment guidelines recommend managing both cholesterol and blood pressure levels. Fewer than one per cent (0.4 per cent) of diabetes claimants also had obesity drug claims. Among obesity drug claimants, 49 per cent had cardiovascular drug claims and 19 per cent had diabetes drug claims. 

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Express Scripts also examined all three patient groups for increased use of the other two drugs as a proxy for disease progression. Between 2018 and 2023, the percentage of plan members also taking diabetes medication increased from 12 per cent to 15 per cent.

Among obesity claimants, 70 per cent were also taking cardiovascular medications in 2018, which increased to 78 per cent five years later, while the percentage of obesity claimants taking diabetes medications increased from 13 per cent to 16 per cent.

More than two-fifths (44 per cent) of diabetes patients who had been on just one medication in 2018 had moved to two or more medications five years later. In addition, 86 per cent of 2018 diabetes claimants were already on a cardiovascular drug, a number that increased to 88 per cent in five years.

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Wong said nutritional therapy, physical activity and psychological interventions are key components of a risk-reduction strategy that slows the progression of all three conditions and can be incorporated into a benefits plan through chronic disease management programs, inclusion of dieticians in the paramedical practitioners list and wellness programs.

From a drug plan management perspective, generic substitution, biosimilar switching and step therapy programs can ensure plan members get clinically appropriate but cost-effective care. She also recommended offering coverage for obesity drugs. “Obesity has been stigmatized and not treated as a chronic disease by our private drug plans, even though it has been recognized by many reputable organizations and clinical bodies.”

Read more coverage of the 2023 Face to Face Drug Plan Management Forum.